The 75,000 resident doctors working across the NHS are the backbone of the service – but too often they are let down on basic issues like payroll errors, poor rota management, lack of access to rest facilities and hot food, and unnecessarily repeating training.
While some progress has been made, it has been too slow, and many still face unfair and inconsistent working conditions.
Supported by our commitment to staff under the recently published 10 Year Health Plan for England, NHS England is setting out 10 ways in which we are improving resident doctors working conditions over the next 12 weeks.
This plan sets out actions for NHS England and individual trusts. To ensure meaningful progress, it will be formally incorporated into the new NHS Oversight Framework.
However, trusts should proceed on the basis that it is already in effect and take appropriate action without delay.
Trusts are also expected to develop a Board Assurance Framework to provide oversight of this work. The outcomes should be included in their annual reports to demonstrate accountability and progress.
Every NHS organisation is required to act across all 10 areas within the next 12 weeks. Progress must be reported to their boards and, where actions are not met, a formal explanation and corrective measures should be provided.
Summary of the 10 Point Plan
- Trusts should take action to improve the working environment and wellbeing of resident doctors
- Resident doctors must receive work schedules and rota information in line with the Code of Practice
- Resident doctors should be able to take annual leave in a fair and equitable way which enables wellbeing
- All NHS trust boards should appoint 2 named leads: one senior leader responsible for resident doctor issues, and one peer representative who is a resident doctor. Both should report to trust boards.
- Resident doctors should never experience payroll errors due to rotations
- No resident doctor will unnecessarily repeat statutory and mandatory training when rotating
- Resident doctors must be enabled and encouraged to Exception Report to better support doctors working beyond their contracted hours
- Resident doctors should receive reimbursement of course related expenses as soon as possible
- We will reduce the impact of rotations upon resident doctors’ lives while maintaining service delivery
- We will minimise the practical impact upon resident doctors of having to move employers when they rotate
1. Improve workplace wellbeing for our resident doctors
Trusts are expected to take meaningful steps to improve the working environment for resident doctors. Issues will vary by location, so trusts can adapt implementation to reflect local needs and operational realities in these and other areas:
- where possible, [provide designated on-call parking spaces]
- the autonomy to complete portfolio and self-directed learning from an appropriate location for them
- access to mess facilities, rest areas and lockers in all hospitals, including new builds
- a 24/7 out-of-hours menu offering hot meals and cold snacks for staff
2. Resident doctors should receive work schedules and rota information as per the requirements of the Rota Code of Practice
From now, and for all rotations going forward NHS England must provide at least 90% of trainee information to trusts 12 weeks prior to rotations commencing.
From now, Trusts must use this information to ensure that resident doctors receive their work schedules at least 8 weeks in advance and detailed rotas no later than 6 weeks before the rotation begins. Where these standards are not met corrective action must be taken. Performance data must be submitted by trusts, and NHS England will monitor and report on national compliance across all stages of the process.3. Resident doctors should be able to take annual leave in a fair and equitable way which enables wellbeing
It is vital that leave is allocated in a way that meets individual needs while maintaining service delivery.
Within 12 weeks, NHS England will: conduct a review of how annual leave is currently agreed and managed for our resident doctors. This review will identify areas for improvement and lead to clear recommendations to ensure a more consistent, transparent and supportive approach across all trusts.4. All NHS trust boards must appoint 2 named leads: one senior leader responsible for resident doctor issues, and one peer representative who is a resident doctor. Both should report to the board
Within 6 weeks, trusts should: appoint a senior named lead for resident doctors’ issues (where one is not already in place), and a resident doctor peer representative, to report to the board.
In September 2025, NHS England will: publish a national role specification for the board lead.
The senior lead will formally take on this responsibility within an existing role, supported by a national role specification to be published by NHS England in September. The resident doctor lead will act as a peer representative and enable trust boards to hear directly from resident doctors themselves. They should be invited to attend board level discussions on issues which specifically relate to improving doctors’ working lives.
Boards should also ensure their executive teams engage directly with resident doctors to understand local working conditions and priorities. This should be supported by national and local data sources (for example, GMC/NET Survey), with improvement plans developed with the same rigour as staff survey responses.5. Resident doctors should never experience payroll errors due to rotations
Following a successful pilot that has reduced errors by half, we are extending the learning from this work to all NHS trusts.
Within the next 12 weeks, every trust should: Participate in the current roll out of the national payroll improvement programme and ensure that payroll errors as a result of rotations are reduced by a minimum of 90% by March 2026. All organisations are required to establish a board-level governance framework to monitor and report payroll accuracy and begin national reporting as required.
6. No resident doctor will unnecessarily repeat statutory and mandatory training when rotating
Within the next 12 weeks if they are not already doing so, every trust should: Comply with agreements set out in the MoU signed by all trusts in May 2025 by ensuring acceptance of prior training.
By April 2026, NHS England will: reform the entire approach to statutory and mandatory training with a revised framework as outlined in the 10 Year Health Plan for England.7. Resident doctors should be enabled and encouraged to Exception Report to better support doctors working beyond their contracted hours
A new national Framework Agreement for Exception Reporting was agreed on 31 March 2025 and will be rolled out for implementation in due course. The changes agreed simplify the reporting process for resident doctors, ensure they are being fairly compensated for the additional hours they are required to work, and will support the safety of their working hours.
We are committed to implementing these reforms as soon as practicable.8. Resident doctors should receive reimbursement for course-related expenses within 4 to 6 weeks of submitting their claims
We will transition nationally from an approach where expenses for approved study leave are reimbursed only after a resident doctor has attended a course/activity, to one where reimbursement is provided as soon as possible after the expense is incurred.
Within the next 12 weeks every trust should: Review their current processes to ensure they can reimburse resident doctors upon submission of valid receipts for all approved study leave-related expenses, including travel and subsistence.
9. We will reduce the impact of rotations upon resident doctors’ lives while maintaining service delivery
A review of how rotations are managed is now underway and is being led by the Department for Health and Social Care (DHSC) in conjunction with the British Medical Association (BMA). NHS England is working closely with the BMA to fully understand trainees’ concerns and to find constructive and workable solutions to address their needs as a matter of priority.
Within 12 weeks, NHS England will: develop and launch suggested pilots of reformed rotational changes, while continuing to look at wider reform.10. We will minimise the practical impact upon resident doctors of having to move employers when they rotate, by expanding the Lead Employer model
NHS England is committed to extending the Lead Employer model to cover all resident doctors and dentists in training. This change will eliminate the need for trainees to change employers with each rotation, reducing duplication and administrative errors while improving continuity, efficiency, and the overall training experience.
By October 2025, NHS England will: develop a comprehensive and financially sustainable roadmap, underpinned by a robust business case. This will include detailed recommendations on costing and funding, service catalogue requirements, and pricing models for national implementation. The roadmap will provide a clear framework for expanding Lead Employer arrangements across the system.Why are we doing this?
- Supporting resident doctors improves the quality of care offered to Many of these steps will also improve the lives of other staff groups across the NHS.
- Our educators work hard to ensure that resident doctors’ education and training is world class, but too often they have been let down on basic issues. The 10 Point Plan will help us respond to what resident doctors have been telling us.
- We have long recognised the need to improve the working lives of resident doctors, but we know we need to go further, faster to build on what we have already done.
Why the focus on resident doctors?
- Resident doctors are different from other staff because they provide care while training in different parts of the NHS, which means they move employer regularly for several years.
- All NHS staff are important, and we will continue to support improvements in working conditions, retention, health and wellbeing and facilities through the 10 Year Health Plan and the forthcoming NHS Workforce Plan.
What have we already done?
| We have piloted a payroll improvement programme with 31 trusts to tackle the root causes of payroll errors leading to a 48% reduction in errors. | 90% of trusts who responded to a recent survey have a named senior resident doctor lead responsible for improving doctors working lives issues and who report directly to trust boards on this issue. |
| Started a national review of the current system of resident doctor medical rotations to reduce administrative and bureaucratic burdens. | Learned from the best local initiatives such as an enhanced focus on sexual safety, health and wellbeing, improved local facilities such as doctors’ mess, on-call facilities and car parking, and enhancements to HR medical staffing teams particularly around reviewing processes to inform these further national plans. |
| We have agreed a new national framework to improve exception reporting. | Established a new national project to explore extending Lead Employer arrangements, allowing resident doctors to have a single employer throughout their rotations. |
What happens next?
We will immediately:
- include this work within the NHS Oversight Framework and work with all trusts to deliver these 10 actions
- ask NHS regions to support and oversee trusts in their delivery
- require trust boards to take clear ownership of local improvements to resident doctors’ working lives by developing and implementing action plans informed by staff feedback and national survey results
- share these actions with all resident doctors via their educators, medical directors and deans, including with the new resident doctors who rotated in August, and expect them to hold us to account
From the autumn we will publish new data and information on:
- trusts delivering access to the basics – lockers, rest facilities, hot meals, on-call parking spaces
- delivery of 8 week work schedules and 6 week rota notice on rotations
- number of payroll errors
- self/preferential e-rostering
- percentage of trusts delivering board level reporting of issues
- changes to the way in which annual leave can be taken